Dr. Hisham Bawakna, is a public health psychiatrist, a PHRI volunteer and a member of PHRI’s medical delegation to the Gaza Strip.

In Gaza, mild post-trauma isn’t considered by local physicians as post-trauma, because it’s normal. Everyone has it.

When do you seek help? When it becomes unbearable, when it interferes with daily functioning, the home, the family, when the crying never stops, when every little sound wakes you up.

My name is Hisham. I’m a psychiatrist who works in the public health care system in Hadera. In March 2021, I went into Gaza for the first time with a medical delegation sent by PHRI. I was the only psychiatrist there.

There’s only one psychiatric hospital in Gaza, and that’s where I went. When I saw the patients, I was amazed. I thought: Wow, that’s post-trauma! Textbook, like you’re taught. In Israel, it’s rarer. I come across a person who I think is experiencing real post-trauma maybe once a month.

What does “real” mean? That if you remember the incident, you relive it, in your body, like there’s a blast going off next to you right now. That’s what it’s like in Gaza.

The psychiatric hospital in Gaza is reserved for extremely difficult cases, psychoses. I met patients who wet their bed, who don’t understand what’s going on around them, lots of kids suffering from anxiety, never-ending crying, intense fear of leaving the house, hypersensitivity to noise.

Their parents bombarded me with questions. I was the only psychiatrist in the room: What do I do when my child wakes up in the middle of the night screaming? And if he asks me what’s that noise, but there’s no noise, what do I tell him?

I was very surprised that most of the physicians at the psychiatric hospital aren’t psychiatrists by training. There are only three in Gaza, and one of them was killed in the last war. The rest learned from experience but didn’t train in psychiatry.

In Israel, to become a psychiatrist, you have to do a five-year residency. In Gaza, there’s no way to do this because the knowledge isn’t there. There’s no one to teach them. The director of the hospital himself isn’t a psychiatry expert.

It’s important for me to stress that the students in Gaza are very talented. I met them – highly motivated people who presented cases to me, really good presentations, even in their first year. But they have no way of training in psychiatry because they’re not allowed to leave Gaza. They can’t travel to Bethlehem, or Jordan, or Jerusalem, or to us in Israel. Nothing. They’re trapped inside because of the closure.

When I got there and saw how the physicians were doing, how meager their training was, I realized it would be more efficient for me to work with the physicians than treat a small number of patients.

They don’t have enough medicine either. For instance, for anti-depressants, there’s only one option, two at most, and it doesn’t always work. For antipsychotic medication – there’s only one option with a very severe side effect. The closure has resulted in a total financial collapse which has hurt hospitals’ ability to buy medicine.

I keep thinking about next time. I learned a lot over there. And I really… for the first time in my life – feel like I’m making a contribution, really making a contribution. And it’s also hard emotionally, hearing these stories. When I go home to my family, I shut everything off. I have no choice. I wouldn’t be able to go on otherwise. I wouldn’t be able to breathe at night. I wouldn’t be able to stop thinking about children screaming and parents trembling and everything I saw. I hear things over there, in Gaza, that could be material for horror stories. So to go back to work, to go on, I emotionally isolate.

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Dr. Hisham Bawakna, is a public health psychiatrist, a PHRI volunteer and a member of PHRI’s medical delegation to the Gaza Strip.

Photo and interview by Yuval Abraham.